N.H. Lawmakers to Take Up Medicaid Expansion Question

Concord — State Rep. Marjorie Porter sympathizes with people who would benefit from New Hampshire expanding Medicaid because she still owes medical bills from the four years when she was uninsured.

“It was very difficult to get the care I needed,” said Porter, D - Hillsborough.

After much angst, a special panel is poised to issue a report Tuesday recommending that New Hampshire add an estimated 49,000 poor adults to the state’s Medicaid program.

But the panel’s vote is far from the final word on a subject that next enters the give and take of political legislative wrangling between Democrats, who favor expansion, and Republicans, who want much greater use of private insurance than the panel is recommending.

Tom Bunnell, policy consultant for the nonprofit Voices for Health, said that while politicians debate expansion, the people who would benefit will continue to seek care from clinics and hospital emergency rooms.

“I don’t think there’s any other choice for people,” said Bunnell, whose group advocates for access to affordable care.

Porter said she knows what it’s like not to have a regular doctor to oversee her asthma treatment. She said clinics sometimes told her to go instead to a hospital emergency room for treatment. In July, she finally got coverage through her husband’s retirement plan and could afford to have a pulmonary test done that otherwise would have cost her several thousand dollars. The test led to better treatment of her chronic illness.

“I couldn’t have done that before,” she said.

State Sen. Nancy Stiles, R-Hampton, who brokered a deal with Democrats to move forward with expansion, won support for expanding the program to poor adults if those with jobs are required to keep their employer’s insurance when it’s cheaper. That requirement will require a federal waiver that Stiles and others believe will be approved.

Stiles said it’s better to expand Medicaid now and broaden the use of private insurance later.

But that idea faces tough scrutiny by Senate Republicans, who narrowly control the chamber. Senate Republican Leader Jeb Bradley said New Hampshire should seek a federal waiver that allows a variety of private insurance options, not just the one Stiles and the panel recommend.

Bradley said last week that GOP Senate leaders are reaching out to Democratic Gov. Maggie Hassan to find common ground and are encouraged so far.

The panel is expected to sign off on a plan Tuesday that urges the Legislature to meet in special session this fall and authorize the expansion beginning Jan. 1. The recommendation is for expansion only if the federal government lets New Hampshire mandate a person staying on an employer’s private insurance plan when it is cheaper than the Medicaid option.

The panel backs a second voluntary option to give people assistance to buy private insurance through the new online markets central to President Obama’s health care overhaul law. Senate Republicans support that idea.

Expansion would add adults under age 65 who earn up to 138 percent of federal poverty guidelines to Medicaid. That would apply to a single adult earning about $15,000 a year and a family of four earning $32,500 annually. New Hampshire’s current Medicaid program covers low-income children, parents with nondisabled children under 18, pregnant women, the elderly and people with disabilities.

If New Hampshire expands Medicaid as part of the law, the federal government would pick up the full cost for the first three years and 90 percent over the long haul. The panel recommends requiring reauthorization of the expansion if the federal government reduces its support.